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` '�r:� PLICATION FOl:��' <br /> : G E�'"° CO N STR U CTI O N °"°'"' <br /> : eVerett PERMIT P+ <br /> BUILDING DEPARTMENT <br /> 259-8810 TO BE COMPLETED IN INK- PLEASE PRINT <br /> � O DEMOLITION � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING ❑ SIGN <br /> [p M�II��DPE55 CIfV ZiP PMONE <br /> / — � � <br /> � �PGMI�EG OR k& NEN M�IL�ODRE55 CIiY 21v PHONE <br /> .F.. <br /> 6ENEMtCONTR�CIOR MMLAOORE55 Cirv ZIP P��ONE L�LENSE• <br /> ' ���E <br /> MECHI1NIGlCONIP�CiOq M�I��pORESS CIfV l�P PNONE IICENSE• <br /> • PLUMBINOCONTR�GTON M�iL�DOPE55 CiTY ZiP pIIONE LICENSE • <br /> CL�SS Oi WORR ,_,// <br /> ' ❑ NEW ❑ ADDITION ❑ ALTERATION LJ REPAIii ❑ DEMOLITION ❑ WOODSTOVE/FRPL.INSERT ❑ BUILDING RELOGITION <br /> � V�LU�TIOHOFWpqNiGO�^ipFM�TERUl5PW5L�BOR1 <br /> �J <br /> , DESC IBE WOPN <br /> ' � � V� <br /> i USE Oi B I ING <br /> ' I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS AP• <br /> PLICATION AND KNOW THE SAMETO BE TRUEANOCORRECT.ALL <br /> � IEO�lDESCRIP1i0NO�PROPERTY�SNOWNBELOWOR�TtACNi0U11COPIE51 PqOVISIONSOFLAWSANDORDINANCESGOVERNINGTHISTYPE <br /> � OF WORK WILL BE COMPLETED WITH WHETHER SPECIFIED HERE• <br /> io�_eiocK—or IN OR NOT.THE GRANTING OF A PERMIT DOES NOT PqESUME TO <br /> . GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF <br /> . ANV OTHER STATE OR LOCAL LAW REGULATING CONSTFUCTION <br /> • OR THE PERFORMANCE OF CONSTRUCTION. . <br /> : SIGNATURE Of CONTR�CTOR OR�UT �(iENT p�TE <br /> X - 1 5� - <br /> VROJECTADDRE59 �PFI�CeN�SCItYB IN SUCENB 10 <br /> ' <br /> PLUMSING • MECHANICAL <br /> � NQ TYPE OF fll[TURE OR ITEM FEE NO. TYPE OF EOUIPMENT FCC <br /> �� W�TERCLOSETITOILET� NC—AMNOIGUNITS—M.P, <br /> BATNTUB REFRIGERATION UNITS—FI.P.EA. <br /> UVATOHY(WASH BASIN) BOILERS—B.T.U./H.P. <br /> SMOM/EN GAS FIRED A.C.UNITS—B.T.U. <br /> ' KITCMEN SINN 6 OISP. FOHCED AIR SYSTEMS—B.T.U. M EA. <br /> DISIIWASMER WAILNEATERS—B.T.U. M <br /> LAUNONYTRAY UNITH�7Eq5—B.T.U. M <br /> CIOTMES wASNER EVAVORATIVE COOLEHS <br /> , URINAL CLOTMESORVERS <br /> . DRINKINO FOUNTAIN yENT1UT10N FAN <br /> FIOOR DRAIN ' qAN6E IIOOD <br /> � ! MCKFLOW PREVENTERS WATER NEATEEi <br /> � ROOF DRIIINS—HAINIEADERS WOOO STOVE <br /> .i SINK(SERVICE—BAR.ETC.) MEfAL FIREPLACE l CMIMNEY <br /> � FIREPLACEINSERT <br /> HEAT P�JMP <br /> 6A5 MPINO <br /> E%MAUSTFAN <br /> i <br /> � lU!TOTAL f !U�TpTAL <br /> . YEIIMIT f KIIWT <br /> TOTALr[E f TOT�Lf[[ <br /> � ��ON17lTMC1c RE�R SETMGR S�OE SETMtK �AN I;MECN NUMBER FEE RECEIPT NO. <br /> ` 1 ue[zou[ �or evee y�C�NT SITE FEES VALUATON FEE <br /> ' OYES ONO <br /> � TYFEOFCONST. OCGUP�NGYGROUP HOAFpM"cIIINGUNITS BUILOING S <br /> PIUMBING <br /> . !RE Of lIDQ NO OF StORIES MSY.p��,�O�D <br /> � MECHANICAL <br /> OTHER <br /> ; FIRE SPRINNLERS REOUIRED ❑VES O NO STATB BUILDIN6 SURCMARGE <br /> STATEENEROYSURCHARGE <br /> � Apv�I��TION�CC B� PLANS CNECNED BY �PPR.FOR ISSU�NGE 9V <br /> PUBLIC WONK9 <br /> ' TOTAI <br /> PROPERTY ONMEp3 ARE RE3PONSIBLE FOR DETERMININ4 ALL <br /> PROPEFiTY LINE LOCATIONS AND RELATED EASEMENTS <br />